Still hobbling

I'm still hobbling around. The ankle is better & I can walk...but it gets swollen & at times it aches a little bit. I worked the weekend & did ok......even walked 2 1/2 miles after work Monday morning! I came home, went to sleep, woke up & ankle felt perfectly fine. I walk 30 feet to my mailbox & suddenly my ankle is aching. Grrr! And last night I tried out that new Kinect thing for Xbox360. Guess it's probably too soon to be jumping & moving side to side...cause my ankle was hurting afterwards. This morning I woke up & it was ok. I wish it would just all go away. It's been 10 days already...when will this swelling stop? I realize no one really knows, but I'm just venting a little. I want to get back to working out & walking without feeling like I'm overdoing it.

Work was ok. I got floated to a med/tele floor on Saturday. Not really sure why someone would order med/tele as opposed to PCU. They both require a heart monitor, but the med/tele floor only does vitals once a shift as opposed to PCU doing them every 4 hours. Oh well, I wasn't complaining. I was busy though & realized they have it far worse than I do. They get 5 patients WITHOUT a tech. That is insane to me. How do they expect us to deliver quality healthcare, yet not supply us with the ability to provide that? Seriously. I'm sure if the patient to nurse ratio was decreased, there would be far less hospital related deaths.

I won't go into that rant. Sunday I was back on my floor & all was fine until about 4:30 in the morning when our fabulous ER (not) gave me a patient with a diagnosis of bronchitis. Turns out his real admitting diagnosis should have been A-fib with RVR. Let me mention...new onset of A-fib too. His heart rate when he got to me was 163. Nice. I called & got a cardizem drip and after all his admission stuff was done, I wrote up the ER for delay of care. He came in 4 hours earlier & all of his EKG strips showed the A-fib & although his HR was not extremely high while in the ED...you could see it was increasing. Started out at 92 & the last strip they showed read 119. How do they not address something like that? Bronchitis at this point was the least of his worries!

Sighhhhhh.......

Sprained Ankle

I have finally started doing something healthy with my life....working out & eating better. I've been walking & walking & walking...and it's paid off. I've lost 7 lbs. I walk every single morning (who am I???). Yesterday I got up & walked when it was just 40 degrees outside. And wouldn't you know it...just as I'm about 2 blocks from my car, I stepped on some debris on the trail & sprained my ankle...as well as scraped up my knee. *%#)#$(!!!!

I don't think it's an extreme sprain as I am able to hobble around. There is no bruising that I can see. Some swelling of course...but I have been following the RICE treatment pretty much....rest, ice, compression & elevation. Since it happened yesterday morning, I had to call in to work because no way could I walk like a nurse needs to walk during her shift. I tried to picture myself in a wheelchair, but don't think my patients would have liked that...not to mention the rooms are so small, I doubt I could even get near my patients while in a wheelchair. I hate calling in though...even when it's 100% legit. I have to rest though. I called in again for tonight...because if I want to get better, I have got to rest it. Hopefully I don't get in any trouble...since I just went to the weekend option & we're only allowed 3 weekends off a year. Oh well, we'll see...but seriously, no way can I walk around for 13 hours.

I am walking to the bathroom & to the kitchen...it hurts, but I know it's good to move it if I can. I woke up this morning & it was all stiff & swollen, but I put some more ice on it & it's a little better. I'm planning to get more rest this week...as long as it takes. Luckily, I have nothing planned & I went grocery shopping last week...so I can last awhile indoors.

I'm frustrated though. I want to get back to walking. I want this pain & swelling gone. I guess in a way it's showing me how I take walking for granted. It was feeling so good walking every morning. I want to get back to that.

It's been about 20 years since I've sprained my ankle...so I ask those of you who are reading this....how long does it take to heal?

Work has been going ok. I am really liking just working 2 days a week. It gives me time to focus on me. I find it easier to get back to a normal sleep schedule. It's nice to be awake during the daylight hours!

I have to go study now. We have a nursing skills lab & this year they are insisting it be hands on & we have to teach them. Ugh. It's one thing to know what you are doing, it's another to have to verbalize it step by step.

Hope everyone is having a better weekend than I!!!!

You Got to Know When to Hold Em...

Know when to fold them, know when to walk away, know when to run......from patient's who are under a Marchmen Act. That song was running through my head last Wednesday night when I was just starting to take report, they handed me a piece of paper with a few details scribbled on it & said "your new admit is on their way up." Uhhh, say what???

Next thing I know, the charge nurse is taking all "dangerous objects" out of the room...like the plastic bags for the garbage & laundry, the blood pressure cuff & 02 sat from the dynamap on the wall, etc. Ummm....he's not suicidal, he's just an alcoholic who the cops brought in because he passed out at a bus stop. She seemed to think it was the same as a Baker Act...which is a person that is a danger to themselves &/or others. Basically a person who was trying to commit suicide.....whether they were really trying or just doing it for attention, we don't exactly know - but all dangerous objects have to leave the room. A Marchmen Act is just someone that is intoxicated & this act is put into place so that they are not allowed to walk out AMA...which most alcoholics would do if given the opportunity.

Anyways, luckily he's asleep (AKA knocked out with Ativan) when he arrives at the floor. The charge now wants me to put paper scrubs on him instead of the hospital gown. Again, this is ridiculous. He is not suicidal. And why can't we just get paper gowns instead of pants & a shirt? Have you ever tried to put a shirt & pants on someone that could get aggravated? Me either, because I wasn't about to start moving him all around in an attempt to put paper clothes on. I told the sitter let's just let him sleep & when he wakes up later, we'll attempt it then.

I took care of my other two patients as quickly as possible, because I just had a feeling this one would be some trouble when he woke up. It was then that I had the bright idea to volunteer to go home at 11, if they needed someone to go home. Best idea I've ever had. And luckily they did indeed need someone to go. He woke up around 10:30 asking for some food & then told me he'd be leaving after he ate. Ummm, no, you can't leave tonight. He wasn't agitated, but I could see that it could go that way. I got him some food, gave report & got out of there as quickly as possible. I just have a hard time dealing with someone that does not want to be at the hospital.

Not because I have a problem with the patient, but because I think they have the right to decide if they want to stay or not. We aren't a prison, we aren't a psych hospital....we are a regular hospital. If he wants help, he knows where to go. Why the cops just didn't take them to their station & let him sleep it off, I don't really know. Maybe they were overcrowded. Still though, it doesn't require a hospital stay to sober up. Meanwhile, we drug them up with Ativan so they are asleep most of the time until they are discharged. That is not a reason to be admitted.

I came home that night, picked up one of my best friend's & we headed to Denny's. It was a blast!

I started my weekend option Sunday night. I got floated to ICU again. Ahhhh!!!!! But this time it was a piece of cake.

I started walking again too. Now that I'm on the same schedule as one of my co-worker/good friend...we are determined to lose some weight. So every morning we're gonna walk.

I have nothing else planned for the rest of the week & it feels great!

Oh Honey Please

That's what I heard over & over my last two shifts at work from my patient....oh honey please....oh honey please....oh honey please. Sometimes it feels weird telling someone much older than me what they can or cannot do. Like this patient for instance....she was 90 yrs old, very unsteady on her feet & what did she want to do...get out of bed & go for a walk. It took two nurses just to help her to the bedside commode that was like 2 inches from her bed, so I knew there was no way I'd be able to take her for a walk. It didn't stop her from asking though...at least a 100 times.

She kept telling me her mother was waiting for her & that her grandmother would be mad if she didn't show up. New nurses might try to reorient 90 yr olds that talk like this. Me, however, I do not. I jump into their world & remind her that her mother & grandmother are fine...that they understand she needs to stay in bed & rest. I'm not about to tell her she's 90 & her mother & grandmother are not around. For all I know...their spirits could be in the room or the hallway or somewhere & she hears them perfectly fine. It's not uncommon to see someone speaking to someone that isn't there. Just because we can't see them, doesn't mean they don't exist, right?

I also did what I was taught a few years ago when you have a confused patient that is constantly trying to climb out of bed. You make the room a little more on the cooler side because then they are more apt to want to stay in bed & under the covers. I used to think that was so cruel when I was a new nurse. Now I totally get it. And it works a lot of the time.

I read an old post of mine from my first year in nursing. It cracked me up to see how naive I was. Now I'm old & jaded....kidding!!!!! But I do have experience on my side. It's weird now to be the experienced nurse on the floor with all the newbies. They all come to me with questions & amazingly, a lot of time I have the answers. It's still weird to me though because I don't feel like the "go to" person. I wonder if I ever will.

I have a co-worker who also happens to be a very good friend of mine. She tends to have a black cloud that follows her...meaning if there is a confused, combative patient...she usually ends up with them. She worked last Sunday & was telling me about this patient that was in restraints & got out of them & was threatening to kick her butt (to put it nicely) & she had to call security for help. Turns out I got him as a patient the next night. However, this patient couldn't have been any nicer. In fact, I had to take his restraints off twice to change his gown & bedding & he willingly let me put them back on. He thanked me for being so wonderful. I crack up because this is usually how it will go with my friend & I. If we are working the same night, she'll tell me about her outrageous patient...I'll walk in the room & the patient will have a nice, non-temperamental conversation with me. My friend stands there in awe. Thus, my nickname is "The Patient Whisperer." She wasn't a believer at first, but now she is...lol.

This is my last free weekend off. I have my brother & his kids over. We went to the mall to do a little shopping last night. I kept asking them "What do you want to do for fun?" One said "Red Lobster", the other said "Zaxby's." Ummm, that's your idea of fun? So as we were sitting down to dinner at Red Lobster, I brought the subject up again. I was throwing ideas out such as Halloween Horror Nights at Universal Studios, a movie, an Orlando Magic basketball game, a haunted house. It all got shot down. Apparently, their idea of fun is much different than mine.

Baylorrrrr Babyyyyyy

Yeah yeah....I'm going Baylor. That basically means instead of working 12 nights a month, I'll be working 8 nights...and get paid the same. The catch is that those 8 nights will always be Saturday & Sunday nights. Doesn't bother me...I'll have 5 days/nights off to do whatever I want. I don't do anything on the weekends that can't be done during the week AND I'll still have Friday nights & Saturday days if need be.

Needless to say...I am a happy camper. And I'll get to work right alongside one of my best nurse friends. Yaysers!!!

This week at work was nail-biting. They floated me to ICU. Ughhhhhh! I will never be an ICU nurse because the stress drives me insane. I am a PCU nurse...which means I am trained to notice when a patient's health has taken a turn for the worse. I notice it, I initiate getting something to help the patient &/OR getting the distressed patient to ICU....so they are in better hands & I no longer have to deal with the stress of a having a patient in distress. It's a win/win. However, when I am the "ICU nurse".....I feel like a newbie. I am stressed the entire shift & absolutely hate it.

I am not trained to work there, but for some reason, it's perfectly ok to float us non-ICU trained nurses to ICU when they are short. I had one patient who had been cardioverted from A-fib with RVR to a junctional rhythm with a heart rate of 30 beats per minute. Scary to me.

And my other patients...admitted with pneumonia BUT also has lung cancer that has mets to other places AND his family refuses to tell him he has any cancer whatsoever. I don't get how this is legal. The patient, while he is in his 80's, was alert & oriented. Isn't it HIS right to know what is going on with HIS body? His son is a pulmonologist & doesn't want his father giving up on life if he were to know he had cancer. What? How is this legal?

Fastforward to my shift with him & this patient was struggling to breathe. Respirations of 40 per min, 100% heated high flow as well as a non-rebreather mask. He would have mini-panic attacks (because he couldn't breathe) & his 02 sat would decrease to 78%. I'd have to calm him down, remind him to breathe through his nose & try to slow down his breathing. This went on all night. I hated it because I know he was suffering. His doctor son was in earlier in the shift & I confirmed the code status of his father = FULL CODE. Insane. He has lung cancer that has mets to other locations & he can barely breathe. It's time to start thinking about comfort care. This isn't a case of pneumonia that we can treat with antibiotics & send on his way.

By the time I left, he was barely keeping an 02 sat of 92% & he was so exhausted from labored breathing that he could hardly open his eyes. I kept asking those around me isn't there anything we can do for him? They told me no...not until he is unable to maintain 92%. I went home with him on my mind & when I came back to work that night, I saw that they had put him on a ventilator. Absolutely insane. I don't get how a pulmonologist could do this to his father. He is trained to know better. I doubt they'll be able to get him off the vent successfully. Needless to say, I hope I don't float back to ICU for a long, long time.

The rest of my week was fine. I actually got to leave a little early on my last shift. Yay....it's rare, but I love when I can leave early. One thing that made me smile at work was taking care of an 89 yr old patient. I went to wash my hands in the sink in her room & she had her curling iron, makeup & other hair accessories surrounding the sink. 89 yrs old and still doing her hair & makeup while in the hospital...lol. Adorable. I love taking care of little old ladies. I don't know why...they are just more enjoyable than anyone else. Of course it helps when they are alert & oriented!

I saw The Social Network & Devil this weekend. I found The Social Network interesting. Especially since it did not have any input from the guy that actually invented Facebook...rather it was the viewpoint of everyone that was suing him because they felt it was their idea. Lame. So even though they tried to portray him as some bad dude, the audience & I still seemed to be 100% on the side of the Facebook CEO. Hard to believe that FB is worth $25 billion. Devil was good.....if you like suspenseful type movies...which I do. Not gory, but plenty of suspense.

Peanut Butter reminds me of YOU

I went into work Sunday night. It was a veryyyy busy night for me. I was ready to ask for an orientation since I had been precepting all year. I forgot how exhausting it can be to take care of patients by myself. Whew!

Anyways, I started out the night with 2 patients. Within 30 min of shift change, I got a new admission. I got her name, looked up the info. Figured I'd have to transfuse some blood. Not a big deal, but can be time consuming with the hourly vital signs. As soon as the patient comes off the elevator with transport, she's saying "I know you!!!!!" I look at her, read her name again...I have no clue who she is. But you can't say that, so instead I try to play along. She starts naming the city I live in, what my favorite pizza is & mentions how she thinks my blue eyes are beautiful. Ok, she does know me...lol. Kidding. But putting all those things together brought it all back. I knew exactly who she was. I had her has a patient about a year ago. It's amazing how you can leave an impression on someone. I mean, I can barely remember what I did a few days ago...much less what some stranger may have crossed my path a year ago.

So I get her settled into bed. Her daughters are with her. She is trying to shoo them out the door by saying she needs to spend some time with me. Inside I am cracking up. This patient is in her late 70's. I have no idea why she is fascinated with me. While her daughters realize I am just a kind person, they are a little peeved their mother is kicking them out. I think at the same time though, they felt ok leaving her there....since she was so happy to see me.

She then brings up how I always brought her peanut butter & graham crackers last time she was there. And then she says "Every time I see peanut butter, it reminds me of you." Lol...cracks me up every time. Who says this to people? So now of course when I see peanut butter, it reminds me of her saying that I remind her of peanut butter. And it probably always will remind me of that.

Her hemoglobin was a little on the low side, nothing critical, but they ordered 2 units of RBC's. She also was feeling a little shaky. I got the blood transfused during the shift & came back the next night to find they were prepping her for a colonoscopy & EGD the next day...to see if there was an active bleed. Luckily, there was no active bleed...but at the same time, no explanation as to why her hemoglobin dropped. That's the part of medicine I don't like...not knowing why something out of the ordinary happens.

I had another patient that came in with a hemoglobin of 5.0. That is critical. Transfused a total of 4 units...but unable to find any active bleed. Huh? And I have this patient in my care for a total of 30 min & his mother is asking me why is he in this condition. Ummmm, I just got out of report. I'm lucky I know his name at this point. She needs to speak with the doctors because I had no info to give her. I felt awful because she was ready to burst into tears with no answers.

I have reached a point where I definitely know I'm getting old. When I think of the above patient, the first thought that pops into my head is "This kid..."....only he's not a kid. He's about 10 yrs younger than me....but as I'm giving report, I hear myself saying "This kid....". Have I reached the point of calling everyone younger than me a kid??? Oh boy. I'm old!!!

Anyways, back to my first patient. We frequently "round" (check in) on our patients. So I stopped by & asked if there was anything I could do for her or get for her. She says "What I've been asking you for all along...your address & phone number." Ummm, I can't give out personal info & at the same time, I'm trying not to even think about why she would want that info. Especially when she asked for my phone number but followed it up with "I'm not going to call you." Huh? Since she asked about 6 times for the information, I gave her one of the hospital business cards with their address & ph number on it. I explained to her that it's against hospital policy to give out personal info. She was fine with it & she loved the business card. Even put it away in a safe place. I'm hoping she's not planning on sending me a year's supply of peanut butter or anything. :)

It's been a strange week. My orientee is on her own for the first time this week & her patient wrote her a 2 page love letter. It was a little on the creepy side, but I'm sure he meant well. We had another patient write a 4 page letter complaining about a doctor. It's just one of those weeks.

Scary moment

This doesn't have to do with nursing, but I had a very scary moment around 3:30 this morning. My precious dog Shay ran away. I had let her out & when I went to call her back in, she was nowhere to be found. I called out for her over & over for 10 min. Nothing.

I grabbed a flashlight & some shoes & headed down this eery dirt road next to my house. I refer to it as the Texas Chainsaw Massacre type road. There are a couple of houses back there & one of them has dogs. I hoped she had maybe wandered over there. While I'm walking, I call my brother. No answer. I call one of my good friends. No answer. Ugh...I'm on my own at 3:30 in the morning to try to find my princess. I call her name repeatedly & get no response. As I got closer to the houses, I worried that one of the homeowner's might come out with a gun & shoot me...because I'm sure I'm the only person that has ever wandered down that scary looking road in the middle of the night.

So I walk back to my house with plans to drive around. I have no idea where to drive around as I live on the main road & other than the dirt road, there aren't many other roads to look on. There are plenty of woods though. I get home & walk in the door & see that Shay has returned. I was sooooooooo grateful. I have no idea where she was, but was glad she was smart enough to know how to come back.

In other news...I bought an iPad!!! I love it. I don't love the price, but I love the item. It is really handy & I'm definitely getting my money's worth.

Work has been ok. It was my orientee's last week & she was sick two of the three days. So I was back on my own. It wasn't bad. I had one quirky patient...when I went into his room, it had to be about 95 degrees. I asked "Why do you want it so hot in here?" He replied "I'm doing laundry." I look over at the air conditioner/heater & he has his socks & underwear sitting on top. Ok, gross. I'm sure that is a fire hazard too, but I got his vital signs & got out of there. I felt like I was in a sauna.

I also had a patient in his late 20's that was just diagnosed with cardiomyopathy. His ejection fraction was approx 32%. That is really poor for someone of that age. His doctor also informed him that he could drop dead at any time with this diagnosis. Then the doctor leaves and my patient is crying. Only he doesn't want me to see that he is crying...so he puts the bedspread over his head. Can you picture this? It was as bizarre as it sounds.

It was a wake up call for me though. I definitely don't treat my body the way I should.....rarely ever exercise or eat right. I'm joining the YMCA tomorrow & will make exercise a priority. The heart needs to be worked out in order to remain strong. I know this. I will do this. The eating...well, that won't be as easy to implement, but I plan to work towards eating better. Baby steps.